LOS ANGELES — He had won “Survivor,” the reality TV test of grit and strength. But Todd Herzog was so drunk when he appeared on the “Dr. Phil” show in 2013 to get help for his alcoholism that he had to be carried onto the set and lifted into a chair.

“I’ve never talked to a guest who was closer to death,” show host Phillip McGraw declared on camera.

TV viewers, however, didn’t see the setup for this shocking scene. Herzog told STAT and The Boston Globe that he was not intoxicated when he arrived at the Los Angeles studio. In his dressing room, he said, he found a bottle of Smirnoff vodka. He drank all of it. Then someone handed him a Xanax, he said, telling him it would “calm his nerves.”

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America’s best-known television doctor presents himself as a crusader for recovery who rescues people from their addictions — and even death. But in its pursuit of ratings, the “Dr. Phil” show has put at risk the health of some of those guests it purports to help, according to people who have been on the show and addiction experts. Guests have been left without medical help as they faced withdrawal from drugs, a STAT/Boston Globe investigation has found, and one person said she was directed by a show staff member to an open-air drug market to find heroin for her detoxing niece.

While McGraw, who has a Ph.D. in psychology, has been buffeted by controversy and lawsuits since he broke out as a celebrity on “The Oprah Winfrey Show” two decades ago, the nationally syndicated show’s handling of guests seeking treatment for substance abuse disorders has largely escaped scrutiny.

McGraw declined an interview request through a “Dr. Phil” show representative. Martin Greenberg, a psychologist who serves as the show’s director of professional affairs, said guests have never been provided alcohol or directed to where to buy drugs.

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In a statement, he denied Herzog was left alone with a bottle of vodka in his dressing room or given Xanax. “We do not do that with this guest or any other,” he wrote. He called the allegations “absolutely, unequivocally untrue.”

“Dr. McGraw has a very strong sense of trying to not exploit people,” Greenberg said in an earlier interview. “Now, it is a television show. These people volunteer to come on. They beg to come on. And he tries to treat them with respect . . . and to give them the opportunity to get help if they want to do that. It’s not a complicated formula.”

Todd Herzog in Salt Lake City, Utah. Matthew Orr/STAT/STAT

But in interviews, show guests and their families described a different reality.

Guests wait up to 48 hours in hotel rooms before their scheduled taping, with the show sometimes filming pre-interviews during that time. As guests wait, they confront a painful and potentially dangerous detox, leading some to look for illegal drugs. One guest bought heroin with the knowledge and support of show staff, according to a family member. Another guest, who was pregnant, was filmed by a show staffer as she searched for a dealer on Skid Row in LA.

“It’s a callous and inexcusable exploitation,” said Dr. Jeff Sugar, assistant professor of clinical psychiatry at the University of Southern California. “These people are barely hanging on. It’s like if one of them was drowning and approaching a lifeboat, and instead of throwing them an inflatable doughnut, you throw them an anchor.”

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The “Dr. Phil” show said staff members have no right to “detain” guests or direct or restrict their behavior, and may not even know the guests are in danger of withdrawal or overdose.

“Addicts are notorious for lying, deflecting and trivializing. But, if they are at risk when they arrive, then they were at risk before they arrived,” Greenberg said in the statement. “The only change is they are one step closer to getting help, typically help they could not have even come close to affording.”

The show’s addiction segments aren’t just compelling TV and good for driving huge ratings: They also serve to boost related businesses. Treatment center operators have been offered valuable endorsements in exchange for buying a new virtual reality product that features “Dr. Phil” offering tips and coping skills to people in treatment.

Centers that buy “Dr. Phil’s Path to Recovery,” priced at $3,500 to $7,000 a month, have been promoted on the “Dr. Phil” show as well as on a second program called “The Doctors” that is owned by the production company founded by McGraw and his son, Jay.

After appearing on the “Dr. Phil” show, many guests are sent to Origins Behavioral HealthCare, an addiction treatment provider so closely associated with the show that some in the field refer to it as the company that Dr. Phil built. Origins, in a Florida licensing report, once bragged that the company has “a reputation that even Dr. Phil recognizes.”

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Origins, which was founded in 2009, lists McGraw’s graduate school mentor, Frank Lawlis, as a member of its executive team. Lawlis has been a key adviser to the “Dr. Phil” show since its inception. His biography on the Origins website indicates Lawlis “consults with Dr. Phil about potential guests, and oversees resources for the guests as they leave the show.”

The show said, through Greenberg, that Origins is one of many treatment centers used as a resource and that the show doesn’t consider Lawlis’s role with Origins a conflict of interest. Greenberg said “no money changes hands” between the show and Origins.

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On television, McGraw, 67, plays the role of a tough-love, no-nonsense adviser with a Southern twang and a dogged determination to help his guests. He promises to “haunt them to the ends of the earth” once he gets involved in their lives. Segments where guests resist his advice often feature harangues from McGraw, prodded by cheering from his studio audience.

Dr. Phil McGraw on "The Tonight Show with Jay Leno" in 2002. Kevin Winter/Getty Images/Getty

Many of his guests view “Dr. Phil” as a savior. Parents come to him begging for help saving their children’s lives. For many treatment centers, his endorsement brings patients and legitimacy; they offer guests free care in return for the show’s promotion. For viewers, McGraw offers hope. Some pepper the show’s Facebook page with their own requests for help, leaving sad stories and phone numbers where they can be reached.

The show seeks to “educate, inform, inspire and entertain our viewers,” Greenberg said. He said hundreds have e-mailed the show “thanking us for helping them face or address an issue that either they, or a family member might be struggling with.” The American Psychological Association presented McGraw its presidential citation in 2006, saying his “work has touched more Americans than any other living psychologist.”

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The show has also made him wealthy: McGraw, according to Forbes, is the nation’s highest-paid daytime TV personality, earning $79 million last year.

McGraw holds a doctorate from the University of North Texas, but has not been a licensed psychologist since 2006, when he let his Texas license expire. He became “Dr. Phil” after he worked with Oprah as a consultant after she was unsuccessfully sued by cattle ranchers in Texas for bad-mouthing the beef industry. He started appearing on her show, and then, in 2002, launched his own.

While addiction is a frequent theme, it is one of many topics addressed by the program.

His show has been the subject of unsuccessful lawsuits by guests, and his forays into the lives of troubled celebrities such as Britney Spears (he offered public comment about her after visiting her in the hospital) and Shelley Duvall (whom he had on the show) have sparked outcries because of concerns they were exploited.

Some of McGraw’s own employees have raised alarms about the treatment of guests. In one lawsuit filed last year against McGraw and his production company in Los Angeles Superior Court, a former segment director, Leah Rothman, accused McGraw of false imprisonment for trapping employees in a room to threaten them over leaks to the media. Rothman also alleged that guests complained that their lives were “ruined.” One guest attempted suicide after the show, according to a deposition with another staff member.

McGraw denied the allegations. Rothman’s attorney said the case was settled and dismissed in September. A representative of McGraw said Rothman was a “disgruntled” employee, and noted that McGraw’s production company is currently suing her in federal court. Rothman’s attorney, however, said she was a hard-working and longtime employee who is “vigorously defending herself” in the federal case.

“Plaintiff’s experience with Dr. Phil was that his primary interest was not about helping people on the show, but rather, done for the sake of ratings and making money,” says Rothman’s suit. “Dr. Phil often embarrassed guests on his show in their darkest hour, leaving the staff to pick up the pieces of the broken people who had put their trust in Dr. Phil.”

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When camera crews arrived unannounced at Todd Herzog’s apartment in Utah in 2013, he had no idea what was happening. The footage that later aired on “Dr. Phil” shows him sitting bewildered and barefoot on his couch, surrounded by his family and a two-person intervention team dispatched by the show after it was contacted by his family.

Herzog’s hands were shaking, and he said he was afraid he was going to die. One of the interventionists explained that Dr. Phil wanted to meet with him. Herzog was a 22-year-old flight attendant when he won “Survivor” — and its $1 million prize. But his life spiraled downward after that, and he said his alcoholism intensified while he was dating someone who was a heavy drinker.

After the show flew him to LA and put him up in a hotel, Herzog said, he detoxed in his room over about two days. In a recent interview in Salt Lake City, he said he was sober when he walked into his dressing room on the set, and intoxicated on vodka and Xanax when he emerged. Herzog’s father, Glen, confirmed in an interview that his son was sober when he arrived at the studio to tape the show.

“Today, I had an entire bottle, like a liter, of vodka,” Todd Herzog told McGraw on stage. When Dr. Phil breathalyzed him in front of the studio audience, Herzog blew a 0.263 — more than three times the legal limit to drive.

“You know, I get that it’s a television show and that they want to show the pain that I’m in,” Herzog said in the interview. “However, what would have happened if I died there? You know, that’s horrifying.”

Dr. Phil confronted Todd Herzog at his home after he suffered a relapse.

Dr. Phil confronted Todd Herzog at his home after he suffered a relapse.

The combination of alcohol and Xanax can be deadly, said Dr. Maureen Boyle, the chief scientific officer for the Addiction Policy Forum, an advocacy organization for patients and families. No one should detox from serious alcohol addiction without medical supervision, she said, as withdrawal can cause seizures.

“The important thing here, this isn’t a TV drama,” she said. “This is someone’s life.”

The show, through Greenberg and a lawyer, offered a series of shifting explanations over two weeks regarding the medical oversight of guests when they go out to LA.

In the interview, Greenberg said the show was not a medical facility, and did not have a responsibility to monitor guests.

“No, of course not, it’s a television show,” he said.

After STAT and the Globe sent detailed questions about Herzog’s case and others, however, the show, in a lengthy response signed by Greenberg, said guests with substance abuse problems are medically supervised “100% of the time.” The show said that any time a guest is likely to need inpatient rehabilitation, medical personnel from a treatment center are flown to LA “to supervise and manage any medical needs.”

Herzog, the response said, was “medically supervised the entire time he was involved with tapings of ‘Dr. Phil.’ ” The supervision, according to the show, included a nurse practitioner flying with him to LA, a nurse sitting up with him during the night, and a medical professional from a treatment center who “happened to be in LA at the time.” The show declined to name any medical personnel.

Then this week, Greenberg, through the lawyer, responded to follow-up questions by qualifying his earlier statements about medical supervision: “We mean 100% of guests agreeing to treatment. It does not mean that a guest is being monitored 100% of the time,” he wrote. He noted that “substance abusers adopt very clever means” to obtain alcohol or drugs, and “we cannot control what we cannot control.”

The director of the treatment center where Herzog agreed to go for help at the conclusion of the show said no one from that facility monitored Herzog while he was involved in the taping of the show.

“I was watching them walk him out severely intoxicated,” said Steve Thomason, who was then the executive director of The Arbor in Georgetown, Texas. “That was the first time I ever laid eyes on him.”

Thomason said he and his medical staff couldn’t offer medical supervision in California because they are licensed in Texas, and the person being monitored must first give consent to treatment and be on the premises of the treatment facility.

He said he was so upset by the condition of Herzog on the “Dr. Phil” show and the manner in which the show was conducted that he never had anything to do with it again.

“I honestly regret having ever done it,” Thomason said.

Other treatment centers contacted by STAT and the Globe similarly said they are barred in most cases from providing the kind of medical supervision described by the show.

Origins, which has treated scores of people who have appeared on “Dr. Phil,” provides a nurse to accompany a patient only on the airplane ride from Los Angeles to one of the company’s addiction treatment facilities in Texas or Florida, said chief executive Drew Rothermel.

Thomason also said he talked to Herzog’s mother after the show, and she told him her son was sober when he arrived at the studio that day.

Herzog’s mother, Shirley Herzog-Keeler, declined to comment on Thomason’s remarks, but said the show helped her son get well. “I have nothing to say but good things” about the show, she said. “We were on the show to help Todd.”

Herzog said the show gave him opportunities to enter treatment, which he is thankful for. He said he was recently contacted by a show producer and asked to write a letter thanking McGraw for his help, which he did.

“I’m grateful in a lot of ways for the show. For getting me help in the nicest places in the country. That’s a gift right there,” he said. “There are some things about the show that I don’t like, and that I don’t think are real. . . . I should have been in the hospital, in that sense. There should not be liters of vodka in my dressing room.”

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Family members of two other show guests said that they had no medical support and, in one guest’s case, that staff members allegedly helped her get drugs.

Marianne Smith’s niece, Jordan, appeared on the show in 2012, in an episode called “Young, Reckless, and Enabled.” Smith said she contacted the show to help her niece break her heroin addiction. Smith said that when she, Jordan, and Jordan’s mother arrived in Los Angeles from Florida, Jordan began going through withdrawal. Smith said she and Jordan’s mother were concerned for her well-being, and told a show producer she needed heroin.

“They told us where to go, Skid Row,” Smith said. “I was so scared.”

The producer also told them not to say who suggested the trip, Smith said. She did not remember the name of the producer.

One reason Smith said she and her sister were so panicked about Jordan’s situation is she had gotten no medical assistance while in LA. “We never had anyone,” she said. “It was just the three of us girls the entire time.” She said the three were in LA for two nights before appearing on the show.

When asked about the experience described by Smith, Greenberg issued a denial: “We could go on and talk about Jordan L. or ten others,” he said. “Same reality. All had medical supervision.”

Joelle King-Parrish brought her 28-year-old daughter, Kaitlin, from Lansing, Mich., to the “Dr. Phil” show in October of last year for help with her heroin addiction. Kaitlin was six months pregnant, and King-Parrish said she assumed that when they touched down, there would be some kind of medical supervision — if Kaitlin went into withdrawal, it could endanger the life of her unborn baby.

But they were alone when Kaitlin began to detox. King-Parrish, who is a registered nurse, said staff members told her to “take care of it.” So she took her daughter to the hospital.

After four hours, Kaitlin left without receiving treatment. The producer texted to say she should stay at the hospital. But Kaitlin would not, and King-Parrish was terrified the baby would die if her daughter did not get medicine or drugs.

King-Parrish and Kaitlin went to the “Dr. Phil” studio, where another show staffer joined them. All three got into a cab headed for Skid Row.

The staffer shot video, which later aired on the show. In it, King-Parrish tells the camera, “I am scared to death right now.” The camera follows Kaitlin from behind as she walks towards homeless encampments. King-Parrish said Kaitlin was gone for about a half-hour while she shot up heroin.

Joelle King-Parrish. Matthew Orr/STAT

The trip made for riveting television. Experts say it could have harmed Kaitlin or her baby.

“That is incredibly deadly. You never know what you’re getting in a single dose,” said Boyle, adding that Kaitlin should have been under medical care the moment she landed in LA.

Greenberg said that show officials agreed to do Kaitlin’s story only if “her mother agreed to be 100% responsible for managing her daughter’s health and possible withdrawal.” The show’s motivation for doing the story, Greenberg said, was to get Kaitlin’s unborn child out of danger.

The staffer that filmed the Skid Row trip, Greenberg said, “simply documented the natural behavior she observed, which would have occurred whether she was there or not.”

The statement said it was unfair to highlight the experiences of a few guests out of thousands who have appeared on the “Dr. Phil” show.

“Few people contact us just to let us know how well things are going,” the show stated. “The fact you can ‘cherry pick’ three, or thirty, or three hundred guests for that matter, who seek to blame others for their plight or struggle in life, is not the least bit surprising.”

Joelle King-Parrish watched footage from her appearance on the “Dr. Phil” show in her home.Matthew Orr/STAT

One guest who credits the “Dr. Phil” show with saving her life is Niki Dietrich, who was eight months pregnant and addicted to heroin when she appeared on an episode last year. She said she was living in an abandoned house with her boyfriend, and prostituting herself for money to buy drugs.

She was sent to an Origins facility after her appearance, and is now sober. The 28-year-old said she is working at a treatment facility and trying to get custody of her daughter.

“That was like a miracle,” Dietrich said of her appearance. “They hooked it up, for sure. The ‘Dr. Phil’ show, I have nothing bad to say about that experience.”

Even after intensive treatment for opioid and alcohol addiction, relapse is common. But the show does not track the success or failure rate of guests for whom it arranges treatment.

“Why, why, why on earth would they?” Greenberg said, adding that the show is not the organization providing treatment.

After his first appearance, Herzog went for treatment but then resumed drinking. When he returned to the show for a third time, in 2014, he found vodka placed in his dressing room again, he said, but this time he was wary of becoming incoherent. He drank some but not all of the bottle. The show denied that vodka was left in Herzog’s room.

Herzog’s last appearance was late last year, and this time, he said, he initiated it. He said the first three times, he felt coerced into appearing. The last time, he wanted the free treatment that guests are offered by centers appearing on the show.

“I know this time . . . I wanted help, I wanted to get sober, because I was dying,” the now-32-year-old Herzog said in an interview. This time, he said, he had a handler who supervised him closely before taping, giving him a shot of alcohol to hold off seizures, Herzog said. He has no memory of what happened on stage.

He knows from watching the show that he was brought out in a wheelchair, then suffered some sort of medical distress.

As staff members rushed to help him, a camera followed him off the set.

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Herzog said this week that he is now sober. He works at a restaurant in Utah; he’s reconnected with friends and family; and he’s dating someone.

“I’m so much happier now. I mean, so much happier,” he said. “I’m living again.”

Jordan, whose aunt said she was directed to Skid Row for heroin, also went to treatment after her appearance, but she didn’t get well, the aunt said.

“It was a complete bust,” Smith said of the “Dr. Phil” show. “Didn’t help at all. Just ratings for him. People are going to him, like us, with serious, life-threatening problems looking for help. It just doesn’t happen.“

McGraw promised Kaitlin “the best help, in my opinion, in the United States,” and, on stage, guaranteed that she would be in treatment until her baby was born. Kaitlin left the treatment center against medical advice after 15 days. Her baby was born addicted in January, King-Parrish said, and went into foster care.

“The treatment facility is not a locked ward, and she is a hard-core heroin addict. That’s what they do,” Greenberg said in his statement. “We deal with people in the real world.”

The show had the family back, after King-Parrish wrote a letter saying she believed their appearance had been “for ratings and not help.” Kaitlin was sent to treatment a second time but kicked out for noncompliance, King-Parrish said.

Today, Kaitlin is homeless and she was recently admitted to the hospital with liver failure, her mother said. Kaitlin did not respond to requests for comment.

“Poor, middle class, high class. Rich. It doesn’t matter. Heroin will take it and kill you. And that’s what I have to make myself know, that that’s probably going to be Kaitlin’s end,” King-Parrish said.